Incidence and Factors Related to Macular Hole Reopening

PURPOSE: To determine the incidence and the factors that can cause a reopening of a macular hole (MH) after a surgical closure. DESIGN: Retrospective, comparative, consecutive case series. METHODS: The medical charts of all patients who underwent vitrectomy with or without internal limiting membrane (ILM) peeling for an idiopathic full-thickness MH were reviewed. In all cases, the MH was closed successfully. Simultaneous phacoemulsification with intraocular lens implantation was performed on all phakic patients who were older than 40 years. RESULTS: Eight hundred and seventy-seven eyes of 831 patients with a mean age of 64.9 +/- 8.0 years were studied. Combined cataract extraction with vitrectomy was performed on 763 eyes of 775 phakic eyes. The mean follow,up time after MH surgery was 57.7 +/- 38.4 months (range, 1 to 175 months). Two groups were studied: an ILM-off group (n = 514) and an ILM-on group (n = 363). The MH reopened in 2 eyes (0.39%) in the ILM,off group and in 26 eyes (7.2%) in ILM,on group (P < .0001). Kaplan-Meier analysis showed higher rates of reopening in the ILM-on group than in the ILM-off group (P< .0001, log-rank test). Factors related to the reopening in the ILM-en group were refractive error (r = -0.12; P =.049) and intraoperative peripheral tear formation (r = -0.13; P = .018). CONCLUSIONS: ILM peeling significantly decreases the incidence of the reopening of an MH. Although the pathogenesis of the reopening of MHs is still undetermined, myopia and intraoperative retinal tears may he related to the reopening. (Am J Ophthalmol 2010;149: 127-132. (c) 2010 by Elsevier Inc. All rights reserved.)